Large uterine fibroids in 34-year-old
This article describes the case of a 34-year-old primigravida diagnosed with large uterine fibroids. The patient’s medical history revealed that she was a non-smoker and had existing fibroids before surgery. The only symptoms she experienced prior to her pregnancy were a lump in her abdomen. On physical examination, her height was 145 cm, weight 55 kg and body mass index was 26.2 kg/m2.
Doctors advised an ultrasound in the first trimester consistent with a large fibroid in the fundus, measuring 16 cm. The growth of the fetus was normal during antenatal care with no signs of malpresentation. The size of the fibroids remained the same during the pregnancy with no other signs of fibroid related complications. Neither did the patient develop any other disorders, including hypertension and diabetes mellitus during pregnancy.
Similarly, before the procedure, the patient was explained the short- and long-term complications of myomectomy. For example, chronic pelvic pain, fibroid recurrence, infertility, abnormal menstruation and increased risk of uterine rupture during subsequent pregnancies. After the patient signed written consent for the procedure, doctors performed a cesarean section with spinal anaesthesia during the 38th week of pregnancy. During the procedure, it was noted that the fetus was in a cephalic position.
Diagnosis and treatment
Once the baby was delivered, doctors exteriorize the uterus to facilitate exploration. Doctors further administered 10 IU of oxytocin intravenously to induce uterine contractions. On exploration, fibroids were detected with a large on the left corpus up to the fundus. At the same time, 2 smaller ones were seen adjacent to the large fibroid. The large fibroid was removed via cesarean section, whereas the smaller ones were removed with uterine incisions above the fibroids.
Doctors further performed a two-layer closure of the uterine wall. The patient had normal levels of haemoglobin before and after the procedure. There was no need for blood transfusions. She was discharged 3 days after the procedure. The mother and baby were both well. The baby weighed 2800 g and there was 400 cc of blood loss during surgery. To confirm the diagnosis histopathological analysis was advised which confirmed the diagnosis of a fibroid, measuring 17 x 16 x 14 cm. Cystic and hyaline degenerations were observed in the fibroid.
Source: American Journal of Case Reports
